HomeMy WebLinkAboutX2022-0003 - Permit Application (2)Prmt.Form ] Worksheet for Combo Building & Solar Permit A H RoF
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F_Comm'I (Residential City of Newport Beach -Building Division X o2�1�0u03 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [ Grading rDrainage (-;Elecj-'Meth Plum cu yd cut cuvdFill
Project Address (Not mailing address) I- Flood r Fire r;Liq r LandslideN/A Floor Suite No
Description of Work Use i
Const Type �;
# Stories[ # Units (if ReS7
-- -- -- --- .---._ -- ..-.-----
Valuation $
New/Add SFF_ RemodelSFF77777 Gara 8 a/New/Add F777 Material/Labor R�� 00c)
OWNER'SNAME Last /V42'./ 4"L -
Owner's Address
City �9°1C31'/LS..- State
APPLICANT'S NAME Last I L Fl, v
Applicant's Address
city hrr --� Rr NII State
First 1 12 cab v /Z
Owner's E-mail Address
Zip �jZ.dz-57 Telephonel?/V-4-2-2-7-5-457
First
Applicant's E-mail Address —�
yY'r/_NC.�e3e�Sj�!t1L /ir,/..6/T� ✓✓le'v� Cba''Gl•�.____._'
Zip �jZ u/ 73 Telephone 5s Q7��a
ARCHITECT/DESIGNER'S NAME Last First
Lic. No
Architect/Designer's Address
City State �—
Architect/Designer's E-mail Address
- -
Zip Telephone[
ENGINEER'S NAME Last First F Lic. NoT—
Engineer's Address
City F77 7-11 State F
Engineer's E-mail Address
Zip �— Telephone�—
CONTRACTOR'S NAME/COMPANYv15�JiF/L ZLS Lic. No. �aZ�yy3i Class,
Contractor's Address
1_77"_jam _. ee15✓ _
City �� ZyYy State �s�
Contractor's E-mail Address
Zip _ 6 Telephone �21 '� 1
�7 _ aarvl-2
SETBACKS REAR SETBACKS FRONT PERMIT N0.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.%�
USE ZONE DEVELOPMENT NO 07,()7 ( r 0y LK PLAN CHECK FEES $